MEDICARE: NEST EMOTIONAL WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MT2152	FL

General Provider Information

NPI Number	:	1649541814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEST EMOTIONAL WELLNESS CENTER

Provider Business Mailing Address
First Line	:	115 MADEIRA AVE
Second Line	:	FIRST FLOOR
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4515
Country	:	US
Telephone Number	:	305-392-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 MADEIRA AVE
Second Line	:	FIRST FLOOR
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4515
Country	:	US
Telephone Number	:	305-392-0788
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. ALINA VEGA
Credential	:	LMFT
Telephone Number	:	305-392-0788

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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